Locking Plate Fixation with Calcium Phosphate Bone Cement Augmentation for Elderly Proximal Humerus Fractures-A Single-Center Experience and Literature Review

Abstract

Proximal humerus fractures (PHFs) are among the most common upper-extremity fractures, with a rising incidence linked to the growing elderly population. Treatment options include non-surgical and surgical methods, but the best approach for geriatric PHFs remains debated. Patient selection for treatment must consider clinical and functional outcomes and the potential complications of surgery. Osteoporosis, a key factor in elderly PHFs, meaning those in patients over 65 years old, often results from low-energy trauma and necessitates treatments that enhance bone healing. Bone cement, such as calcium phosphate, is widely used to improve fracture stability and healing. However, the benefits of surgical fixation with bone cement augmentation (BCA) for elderly PHF patients remain controversial. Hence, in this article, we searched databases including MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science to analyze the evidence on locking plate fixation (LPF) with BCA for proximal humeral fractures. We aim to provide readers with updates concerning the above issues.

Keywords: bone cement augmentation; elderly proximal humerus fracture; operative management.

Figure 1

Comparison of LPF with (A1–A3) or without (B1–B3) CPBCA in elderly PHFs: Patient A: (A1) A left PHF was presented. (A2) Treated with LPF with CPBCA. (A3) Post-operative X-ray at 12 months follow-up; Patient B: (B1) A left PHF was presented. (B2) Treated with LPF without CPBCA. (B3) Post-operative X-ray at 12 months follow-up. By comparison, the patient managed with a combination of LPF and CPBCA fared better with a stable head of humerus, maintained neck–shaft angle, and position of greater tuberosity fragments; in patient B, who had LPF without CPBCA, the head of humerus had a progressive collapse, the neck–shaft angle was reduced, and greater tuberosity fragments were migrated (arrow).